AB1454 CLINICAL AND BIOLOGICAL FACTORS CORRELATED WITH MAGNETIC RESONANCE IMAGING RESULTS IN TUBERCULOUS SPONDYLODISCITIS
Authors: M. Mrabet, S. Boussaid, S. B. Troudi, S. Rekik, S. Rahmouni, S. Jemmali, H. Ajlani, H. Sahli, M. Elleuch
Journal: Annals of the Rheumatic Diseases (2022)

Background Tuberculosis is still endemic in Tunisia. Although pulmonary localization is the most common, other localizations, including osteo-articular involvement, are increasingly diagnosed. Tuberculous spondylodiscitis (SPDT) or Pott’s disease is an infectious involvement of the disc-vertebrate couple, caused by the tubercular bacillus (Mycobacterium tuberculosis). Magnetic resonance imaging (MRI) is the most sensitive (95-100%) and the most early abnormal exam. Objectives Our aim was to study the correlation of contributing factors, epidemiological, clinical, biological, radiological and therapeutic data with positive signs of spinal MRI. Methods We conduct a retrospective and descriptive study in a single rheumatology department. Data were collected from observations of patients hospitalized in the past 20 years (2000-2020) who have been diagnosed with SPDT. Epidemiological, clinical, biological, radiological, and therapeutic data were analyzed. Each patient had spinal MRI. Positive signs have been individualized, represented by intervertebral disc involvement, vertebral body involvement and visualization of a paravertebral abscess. Results Fifty-two cases of SPDT were collected (37F/15M). The mean age of the population was 55.21±17.79 years [19-91]. Thirty-three patients (69.2%) were classified as young versus 16 elderly patients (30.8%), with female predominance in both groups (69.4% and 75% respectively, p = 0.57). The positive diagnosis of tuberculous spondylodiscitis was facilitated by the spinal MRI. Positive signs were sought in our patients which are represented by: the achievement of the intervertebral disc with diffuse T2 hypersignal (56.5%) and diffuse or circumferential increase of the signal in sp T1 Gadolinium (50.9%), Involvement of the vertebral body with moderate and extensive condensation (60.4%), macrogeodes (60.4%) and heterogeneous increase in spT1 Gado signal (52.8%) and visualization of a paravertebral abscess (51.9%). Correlations made between the favouring factors, epidemiological, clinical, biological, radiological and therapeutic data and the positive signs of spinal MRI, objecting that six parameters had a statistically significant correlation with MRI signs strongly suggestive of the diagnosis of SPDT: Hospitalization duration was correlated with the diffuse T2 disk hypersignal (p= 0.02; r= - 0.38), Hemoglobin rate was correlated with the diffuse or circumferential increase in T1 disk sp signal (p= 0.03; r= - 0.34), the initial rate of lymphocytes was correlated with the paravertebral abscess (p= 0.04; r= - 0.47). The extra-vertebral tuberculosis location was correlated with the diffuse T2 disc hypersignal (p= 0.03; r= -0.96), the moderate condensation and the extent of vertebral body (p &lt; 0.001) and vertebral body macrogeodes (p &lt; 0.001). The neurological clinical signs were correlated with the heterogeneous increase in vertebral body T1 sp signal (p= 0.04; r= -0.33) and the surgical treatment (p &lt; 0.001). Conclusion Tuberculous spondylodiscitis is a frequent condition that needs to be diagnosed and treated rapidly. Spinal MRI is the first-line exam in case of suspicion. Clinical, biological and therapeutic parameters were correlated with the MRI images highly suggestive of positive diagnosis. Disclosure of Interests None declared